Provider Demographics
NPI:1063003499
Name:STIDHAM COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:STIDHAM COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STIDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:515-451-7523
Mailing Address - Street 1:2036 N 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4712
Mailing Address - Country:US
Mailing Address - Phone:515-451-7523
Mailing Address - Fax:
Practice Address - Street 1:10824 OLD MILL RD STE 10-2
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:515-451-7523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health